Provider Demographics
NPI:1154412989
Name:OLIVE, GEORGE CHAPMAN II (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:CHAPMAN
Last Name:OLIVE
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 802843
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2843
Mailing Address - Country:US
Mailing Address - Phone:417-269-5712
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:3555 S NATIONAL AVE STE 502
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7310
Practice Address - Country:US
Practice Address - Phone:417-269-7444
Practice Address - Fax:417-875-3459
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR9G11208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158168001Medicaid
MO202546818Medicaid
MO202546818Medicaid
AR158168001Medicaid